Saskatchewan’s Ministry of Health is leading a new approach to strategic planning based on deep organizational engagement and collaborative decision making.
Strategic planning has earned a bad reputation within many organizations, principally because it is perceived as a top down, non-value added process that often does not lead to transformational changes. Typically organizations try to accomplish too many strategic goals, and strategic plans are often developed but not as effectively executed as they could be. There is often a gap between strategy and action in traditional planning approaches and employees can end up feeling disengaged from key strategic initiatives.
Leaders within Saskatchewan’s healthcare system are overcoming these shortcomings through the adoption of hoshin kanri, a management process that helps senior leaders focus and align their organizations around a few key goals.
Hoshin kanri, part of an overall lean management approach, is based on a number of key premises. First, the insight and creative talents of all employees within an organization or system need to be effectively brought to bear on organizational problems and opportunities. Second, organizations will only achieve desired results if they focus on a small number of “breakthrough” initiatives at one time. In any organization, there are too many things to accomplish, inadequate resources and multiple distractions. Third, planning should involve and be done by those who are expected to implement the work. And fourth, implementation and results must be routinely and rigorously measured.
Participants within the Saskatchewan health system have completed one cycle of hoshin kanri, which has resulted in an unprecedented level of involvement from both health leaders as well as others within the system. Approximately 1,000 people were engaged in the development of the 2012-13 health system plan. Leaders affirmed a strategic focus on a quadruple aim of Better Health, Better Care, Better Value and Better Teams to improve health care for Saskatchewan residents.
A Provincial Leadership Team, consisting of 21 health system leaders (representing health regions, the Ministry of Health and health organizations as well as a physician representative), was engaged in the development and finalization of the plan for a total of seven days. Four of these days were dedicated at the beginning of the cycle to developing a draft plan and three days were dedicated at the end of the cycle to reviewing organizational feedback on the draft plan.
Each organization held, at a minimum, a series of four-day meetings with middle management to review and provide feedback on the draft plan. This stage of the process is referred to within hoshin kanri as “catchball,” meaning that the draft plan developed at the Provincial Leadership Team level was passed to each of the participating organizations for review, feedback and refinement.
Once this stage of the process was completed, feedback was then passed back to the Provincial Leadership Team, which met for three days to finalize the plan. This important step helps ensure organizational alignment and system-wide agreement at a senior executive level.
Hoshin kanri not only increases engagement within an organization through the catchball process, but also increases the level of accountability expected for achieving results. Saskatchewan has established visibility walls at both a provincial and organizational level.
Visibility walls contain the outcomes and targets the health system is striving toward as well as key projects and measures to assess performance toward those outcomes and targets. Provincially, the visibility wall is reviewed on a quarterly basis; at an organizational level it is reviewed on a monthly basis.
As part of the hoshin kanri process, health system leaders are assigned “ownership” for results on certain outcomes, targets, projects and measures. During reviews each leader has to speak to their area of responsibility and explain whether projects and goals are on target. If projects are not on target, leaders are expected to explain what the barriers are and what will be done to get the project back on track.
Feedback within Saskatchewan to date has been overwhelmingly positive. The process is resource-intensive but that intensity results in increased employee engagement, organizational alignment, and the necessary focus for the achievement of results.
The Saskatchewan health system will begin the second cycle of hoshin kanri in September and leaders have a long-term goal of engaging all 42,000 provincial healthcare employees in the development of strategies and solutions to provincial healthcare problems.
David Howland is a senior policy analyst for the Health System Planning Unit in Saskatchewan’s Ministry of Health.